title: The emotional impact of medical error involvement on physicians: a call for leadership and organisational accountability.
abstract: OBJECTIVE
  Involvement in errors often results in serious health effects, emotional distress, as well as performance and work-related consequences in staff members, in particular physicians. The aim of this systematic review was to evaluate current evidence on a) the impact of involvement in medical errors on physicians, b) needs and experiences in coping with the experience of error, and c) interventions to support physicians involved in errors.
  
  
  METHODS
  A systematic review was conducted in a two-step procedure using predefined search protocols and inclusion criteria that cover the relevant literature published between 1980 and 2007.
  
  
  RESULTS
  Of 3,852 identified candidate articles, 87 studies were selected for critical appraisal and 32 were included in the review. Involvement in medical errors often provokes intense emotional distress that seems to considerably increase the risk for burn-out and depression. The evidence suggests a reciprocal cycle of these symptoms and future suboptimal patient care and error. Communication and interaction with colleagues and supervisors are perceived as the most helpful resource by physicians. Physicians involved in errors usually feel not supported in coping with this experience by the institutions they work in.
  
  
  CONCLUSIONS
  Many professionals respond to error with serious emotional distress, and these emotions can imprint a permanent emotional scar. Given the significant burden on physicians' health, well-being and performance associated with medical errors, health care institutions and clinical leaders have to take accountability and provide staff with formal and informal systems of support.
authors.affiliation: Swiss Patient Safety Foundation, Zurich, Switzerland. Schwappach@patientensicherheit.ch
authors.forename: David L
authors.initials: DL
authors.lastname: Schwappach
authors.forename: Till A
authors.initials: TA
authors.lastname: Boluarte
mesh_terms: D000223:Adaptation, Psychological; D002055:Burnout, Professional / Q000453:epidemiology; D058016:Health Facility Administration; D006801:Humans; D007857:Leadership; D019300:Medical Errors / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D012449:Safety; D012941:Social Responsibility; D013315:Stress, Psychological / Q000453:epidemiology